Calciphylaxis: A Rare Manifestation of a Common Disease

Calciphylaxis is a rare complication, typically observed in patients with end-stage chronic kidney disease (CKD), in the presence of risk factors such as secondary hyperparathyroidism, female sex, and diabetes mellitus, among others. It is characterized by painful cutaneous lesions resulting from calcification of arterioles, leading to vascular occlusion, tissue ischemia, and necrosis. We report the case of a 71-year-old woman with a history of CKD, Kidney Disease: Improving Global Outcomes G5 (KDIGO G5), secondary to diabetic nephropathy. As a relevant risk factor, she presented with secondary hyperparathyroidism associated with renal disease. She was admitted to the Emergency Department with erythematous and edematous plaques on both lower limbs, accompanied by severe pain. Laboratory evaluation revealed normocytic normochromic anemia, hyperphosphatemia, normal serum calcium levels, and elevated parathyroid hormone (PTH). The patient was hospitalized for etiological investigation. A skin biopsy obtained during hospitalization confirmed the diagnosis of calciphylaxis, revealing vascular calcifications and panniculitis. Treatment was initiated with opioids for pain control and topical heparinoid for the management of skin lesions. Following discharge, the patient remains under follow-up at the Nephrology clinic, with no recurrence of cutaneous lesions. This case underscores the importance of early diagnosis and a multidisciplinary approach in the management of calciphylaxis, a rare but potentially life-threatening condition associated with high mortality.